Flat Feet in Children

Flat Feet Treatment Strategies for Children

You may have heard the term pes planus, flat feet, no plantar arch support, or overpronation… You may notice your child’s feet turning out significantly when standing or walking. You may even notice a more significant wear pattern on the inside of the child’s shoe. So what exactly does a flat footed presentation entail?

Flat Feet (aka Pes Planus)

Children who present with flat feet may have been late ambulators, may have been initially classified as toe walkers, or may have been diagnosed with hypotonia. When the child is standing, you will notice the entire foot contacting the weight bearing surface with the absence of an inner (medial) arch. The foot may also turn out, increasing the weight on the medial side, and making it appear even more flat. When assessing this child’s gait, you may notice audible “foot slap”, denoting a lack of true control as compared to more typical gait pattern (as weight shifts from heels to toes).

Children with flat feet will experience overpronation or excessive pronation, which refers to a pattern in which the foot rolls too far in a medial direction causing the body weight to be distributed unevenly across the metatarsus and cause excessive strain on the ankle, the knee and the hip. A child who overpronates does not absorb shock efficiently, leading to poor lower extremity alignment and the potential for future orthopedic concerns.

It is important to note that most children will appear with a flexible flat foot early on in their “walking career”. We anticipate early ambulators to display a flattened arch with forefoot pronation while weight bearing. Over time most children develop the musculature of their intrinsic foot and plantar arch. Intervention is not necessary if this presentation is not otherwise affecting function.

Here are some fun treatment ideas to promote development of the arch muscles to encourage lower extremity alignment, fluidity of gait mechanics and prevent any potential long term musculoskeletal issues that may arise as a result of this presentation.

All exercises should be done barefoot without sock or shoes, to encourage activation of the intrinsic muscles of the foot. We want child to experience both tactile and proprioceptive input through the soles of their feet.

Standing with one foot in front of the other, make sure you practice alternating with left foot first and right foot first.

The tactile footprints are great visual and tactile cues for foot placement to help engage foot musculature and promote development of arch!

Scooter Adventure

Seated floor scooter, forwards and back using heels to dig in and muscles of foot to initiate movement.

Crab Kicks

Hold bridge position as shown below, and perform alternate leg kicks while saying the ABCs. To increase challenge and to target muscles of the foot, place Dyna-Disc under feet, while alternating leg kicks!

Bear Walks

Have child walk across the room like a bear to complete a puzzle. You can increase the challenge and provide sensory input by lining the floor with bubble wrap!

Line up 4-5 large pillow or couch cushions, encouraging child to walk along. Offer support for balance if necessary. Great to practice negotiation, engaging muscles of lower extremity and targeting mechanics of gait.

Floor Skating

Using colored spots, with child barefoot encourage them to keep feet on the spots while sliding forward on the floor. This will encourage child to grip with their feet and activate their intrinsic arch muscles as they move along.

Heel Walking (aka Penguin Walking)

Encourage child to walk forward with heels on the ground and toes up!

Side Stepping

Encourage child to step side to side with feet facing forward. Can use small obstacle to step over for increased challenge.

Thank you to Dr. Sneha Gosalia, PT, DPT for her helpful contributions to this post in the form of exercise/activity ideas as well as wonderful photos! Take a moment to visit her practice website, Big Leaps CT.

THIS IS AWESOME!!!! THANK YOU THANK YOU SO VERY MUCH!!! I cannot express it enough. Thank you! I just had my child examined for a 2nd opinion and doc said to keep wearing orthodics, but I will definitely try these exercise ideas too.